Cosmetic Procedures For Children Pose Ethical Dilemmas

Main Category: Pediatrics / Children's Health
Also Included In: Dermatology;  Cosmetic Medicine / Plastic Surgery
Article Date: 27 Jan 2009 - 2:00 PST

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More children than ever are undergoing medical procedures for nonmedical purposes-breast enhancement and liposuction, as well as "Westernizing" eye surgery for Asian children and cosmetic interventions to correct physical deformities. An essay set in the current issue of the Hastings Center Report examines what-if any-justifications there are for parents to consent to changing their child's physical nature. .

The lead essay opens with the case of a white father who sought "Asian eye surgery," or blepharoplasty, for his adopted Asian daughter. The surgery, common among Asians in the U.S. and abroad, is performed on babies and young children in the belief that it will make them more attractive and confer a competitive advantage. But because the shape of the eye is, for some, an integral part of their identity, parents who consent to the surgery limit their children's autonomy by taking away their right to make a decision central to their identity as adults, argues Alicia Ouellette, an associate professor of law at Albany Law School.

Three of the essays follow up on the most controversial case of cosmetic surgery in a child: Ashley, a girl with profound cognitive disabilities who had treatment in 2004 to prevent puberty, thereby making it easier for her parents to care for her at home. Two doctors involved with the Ashley case, Douglas Opel and Benjamin Wilfond of the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Center, discuss other examples of cosmetic surgery in children with severe cognitive disabilities and argue that such surgery may be justified even if the psychological benefit to the parents is clearer than any benefit to the child.

Erik Parens, senior research scholar at The Hastings Center, offers insights to parents who are considering cosmetic surgery for children with profound cognitive impairments. These insights are from children with physical disabilities who have considered cosmetic surgery and their reasons for having it or deciding not to have it.

Gregory Kaebnick, Hastings Center research scholar and editor of the Hastings Center Report, analyzes one of the objections to the Ashley treatment-that it was "against nature." Kaebnick suggests that a moral position on whether to leave nature alone is a deeply personal matter. It does not follow either that changing nature is "wrong" or that giving considerable personal freedom on these issues is bad public policy, writes Kaebnick, who recently completed a research project on moral appeals to nature that was funded by the National Endowment for the Humanities.

The final essay poses a dilemma faced by parents of young boys with gender identity disorder, who identify as girls: should the parents intervene with psychotherapy to try to make the gender identity disorder dissipate, or should they accommodate the child on the assumption that he was born with a female brain in a male body? Evidence for each of these options is lacking-and is "mired in long histories of identity politics," writes Alice Dreger, a professor of medical humanities and bioethics at the Feinberg School of Medicine at Northwestern University. Dreger gives parents some points to consider, including the trajectories of each option, given the odds that a boy who identifies as a girl will continue to do.

The Hastings Center is a nonpartisan bioethics research institution dedicated to bioethics and the public interest since 1969. The Center is a pioneer in collaborative interdisciplinary research and dialogue on the ethical and social impact of advances in health care and the life sciences. The Center draws on a worldwide network of experts to frame and examine issues that inform professional practice, public conversation, and social policy.

The Hastings Center